Evaluation on Malignant Transformation of Oral Lichen Planus

目的：口腔扁平苔藓（oral lichen planus,OLP)是否属于癌前病变，至今仍存在较大的争论。本文的目的在于评估OLP的癌变性质。方法：报告1995－2002年之间9例OLP的癌变病例。结果：5例OLP患者同时或继发为口腔鳞状细胞癌，1例为疣状癌，3例为上皮异常增生。其中7例发生在原OLP存在的部位，1例发生在其它部位，1例在同一部位同时存在OLP和鳞状细胞癌。OLP的癌变常发生在糜烂型和萎缩型，发生于颊粘膜，舌或牙龈。根据所制定的OLP的诊断及癌变标准，4例OLP患者发生了癌变。结论：OLP具有一定的癌变潜力，对OLP患者应每年随访2－4次，尤其是对发生在颊粘膜，舌或牙龈的糜烂型和萎缩型的患者。     

Epidemiology and survival outcomes of lip,oral cavity,and oropharyngeal squamous cell carcinoma in a southeast Brazilian population

Background Lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC) represent a major health problem in the global scenario. In South America, the highest incidence rates are seen in Brazil. Therefore, the epidemiological and clinical profile and survival outcomes of lip, oral cavity, and oropharyngeal SCC was studied in São Paulo State, Brazil.Material and Methods The clinicopathological data of 12,099 patients with lip, oral cavity, and oropharyngeal SCC were obtained from hospital cancer registries of the Fundação Oncocentro de São Paulo, Brazil (2010–2015). Survival rates and other analyses were performed using SPSS software.Results A clear male predominance was observed, particularly for patients with oropharyngeal SCC (88.3%). The average age of patients was higher for lip cases (65 ± 13.5 years) compared to other sites. The schooling level was low for most patients, especially in lip cases (87.9%). Most of the patients with oral cavity (71.8%) and oropharyngeal (86.3%) SCC had advanced-stage (III–IV) disease. However, the majority of lip cases (83.3%) were at an early stage (I–II). Surgical excision was the main treatment for lip (72%) and oral cavity SCC (23.5%), and chemoradiotherapy was the main treatment for oropharyngeal SCC (40.2%). The 5-year overall survival (OS) for patients with lip, oral cavity, and oropharyngeal SCC were 66.3, 30.9, and 22.6%, respectively. Multivariate analysis revealed that the determinants of OS were different for lip, oral cavity, and oropharyngeal SCC, except for those at the clinical stage, which was an independent predictor for all sites.Conclusions OS-independent determinants varied according to the affected site. Oral cavity and oropharyngeal SCC presented worse survival rates than those for lip SCC. Key words:Squamous cell carcinoma of head and neck, lip neoplasms, mouth neoplasms, oropharyngeal neoplasms, survival analysis.     

Oral cGVHD screening tests in the diagnosis of systemic chronic graft-versus-host disease

To determine the diagnostic properties of oral manifestations and histological features of graft-versus-host disease (GVHD) screening tests in the diagnosis of systemic chronic graft-versus-host disease (cGVHD). Sixty patients having undergone allogeneic haematopoietic stem cell transplantation were selected. The patients were submitted to a clinical oral examination to assess symptoms and clinical changes in the oral mucosa. Histopathologic analysis of the lower lip oral mucosa (LLOM) and salivary glands (SG) was also performed. Systemic cGVHD was used for a comparison to oral cGVHD. The accuracy of oral cGVHD tests was low for all methods (58.4% and 52.6% for white lesions and white/red lesions, respectively, in the clinical analysis; 50.4% for the presence of oral pain; and 66.8% and 55.1% for LLOM and SG histopathologic tests, respectively). However, the presence of oral pain had good diagnostic properties [specificity: 100.0, 95% confidence interval (CI): 88.0–100.0; positive predictive value (PPV): 100.0, 95% CI: 94.4–100.0; and negative predictive value (NPV): 72.0, 95% CI: 57.3–83.3]. Moreover, SG alterations revealed by the histopathological analysis also exhibited good diagnostic properties (sensitivity: 98.6, 95% CI: 81.5–99.8; PPV: 71.1, 95% CI: 62.1–79.7; NPV: 85.9 95% CI: 32.9–99.4). The clinical severity of oral lesions and histophatological changes in the LLOM did not exhibit adequate diagnostic properties, whereas both oral pain and SG histopathological analysis exhibited adequate properties for the diagnosis of systemic cGVHD. Histological changes in lip oral mucosa and salivary glands together with a clinical manifestation of the disease in the oral mucosa can be useful to determining the systemic cGVHD.     

Actinic cheilitis: clinical and pathologic characteristics in 65 cases

OBJECTIVE: The purpose of this study was to determine the clinical and histopathologic presentation of actinic cheilitis. STUDY DESIGN: A retrospective study on 65 patients attending an Oral Medicine clinic in Greece over a 10 year period. For each case the demographic, clinical and histopathologic information were evaluated. RESULTS: The mean age at the time of diagnosis was 53.1 +/- 11.4 years. Thirty-nine patients (60%) used tobacco in any form. An outdoor occupation was indicated for 43 (66.2%) patients. The location of the lesions of actinic cheilitis was in all cases on the lower lip. Actinic cheilitis appeared in three forms; white non-ulcerated lesions (29%), erosions or ulcers of the lip (48%), mixed white and erosive (23%). The histopathologic characteristics included increased thickness of keratin layer, alterations of the thickness of spinous cell layer, epithelial dysplasia, connective tissue changes, perivascular inflammation and basophilic changes of connective tissue. In 11 cases (16.9%) the presence of squamous cell carcinoma was observed. CONCLUSIONS: This case-series highlights varied clinical presentation of actinic cheilitis among whom a high proportion developed squamous cell carcinoma.     

唇癌微血管密度和血管内皮生长因子表达的意义

目的　研究唇鳞状细胞癌组织中微血管密度 (MVD)和血管内皮生长因子 (VEGF)的表达和意义。方法　采用CD34和VEGF单克隆抗体 ,用免疫组化S P法对 4 2例唇鳞状细胞癌标本进行免疫组化染色。结果　唇癌组织MVD显著高于正常对照唇组织MVD(P <0 .0 0 1)。有淋巴结转移唇癌的MVD高于无淋巴结转移的MVD ,但两者之间无显著性差异 (P >0 .0 5 )。唇癌组织和正常组织中VEGF表达阳性率分别为 6 1.90 %和 10 .0 0 % ,两者间有显著性差异 (P <0 .0 0 1)。有淋巴结转移组VEGF阳性率 (80 .0 0 % )高于无淋巴结转移组VEGF阳性率 (5 6 .2 5 % ) ,但两者间无显著性差异 (P >0 .2 5 )。VEGF阳性表达唇癌的MVD高于VEGF阴性表达唇癌的MVD ,两者间有显著性差异 (P <0 .0 2 )。结论　唇癌中VEGF的表达与MVD有密切的联系 ,说明VEGF能较好地反映唇癌微血管生成的活跃程度 ,是一个重要促血管生成因子     

Oral cancer over four decades: epidemiology,trends, histology,and survival by anatomical sites

J Oral Pathol Med (2010) 39 : 299–305 Background: Oral cancer is one of the few life‐threatening oral diseases. The subtypes and different sites of oral cancer has different etiology epidemiology and survival rate. Prevalence of the various anatomical oral sites provided potential baseline for improvement of clinical approach. Methods: Incidence and survival rates were derived from the Israel National Cancer Registry and included all registered data between 1970 and 2006. Oral cancer included the lips, tongue, buccal mucosa, gums, vestibulum, floor of the mouth, and palate. Results: Most prevalent oral cancer subtype was squamous cell carcinoma (SCC) among men above the age of 55 years. Females had a higher incidence of SCC in lateral border of tongue, gums and buccal mucosa. Lymphoma and sarcoma were the most prevalent under the age of 20. Melanomas and metastatic disease revealed the lowest survival rate, while invasive or infiltrating basal cell carcinoma in the lips had the highest rate. The highest oral survival rate was for the lip, and the lowest was for the tongue and gums. Conclusions: Early detection of oral cancer is important for all the medical health team. Decrease in lip carcinoma may be a result of occupational or awareness changes and should be studied. Non‐epithelial tumors under the age of 20 should be considered as a differential diagnosis. A basic oral examination should be included in all routine medical examinations, with emphasis on high‐risk patients and high‐risk oral sites.     

Potentially malignant and malignant lesions of the lip. Role of silver staining nucleolar organizer regions, proliferating cell nuclear antigen, p53, and c-myc in differentiation and prognosis

The cellular changes leading to carcinoma of the lip are still not completely understood. This study was carried out on 44 malignant and potentially malignant lesions of the lower lip [30 squamous cell carcinomas (SCC), 7 actinic cheilitis, 3 leukoplakias, and 4 nodal metastases from lower lip SCC]. Silver-stained nucleolar organizer regions (AgNORs) and the immunohistochemical expression of proliferating cell nuclear antigen (PCNA), p53, and c-myc were evaluated on formalin-fixed, paraffin-embedded sections. The results indicate that the size and numbers of AgNORs and the percentage of PCNA-positive cells are sensitive parameters for discriminating between potentially malignant lesions and SCC, and for the prognostic sub-typing of lower lip SCC. Furthermore, while p53 positivity was found more frequently in high-grade carcinomas, p53-positive cellular clones were also found in some potentially malignant lesions, a finding probably related to ultraviolet-related cellular damage. These p53-positive lesions could be considered at higher risk of progression to malignancy than the p53-negative ones, although there is no evidence for this as yet. c-myc positivity was found only in some high-grade carcinomas and metastases, and appeared correlated with the later phases of lip carcinogenesis. The combined evaluation of the proliferation status, together with the changes in p53 and c-myc oncoproteins, might constitute useful markers for the prognostic evaluation of potentially malignant, as well as malignant, lesions of the lip.     

Intravascular papillary endothelial hyperplasia of the mouth: report of six cases and literature review

OBJECTIVE: Oral intravascular papillary endothelial hyperplasia (IPEH) is an uncommon, reactive vascular lesion with no specific clinical features. Microscopically two subtypes have been described: a pure and a mixed form. The importance of IPEH is in its resemblance to angiosarcoma. The aim of this study was to evaluate both the prevalence of IPEH in a consecutive series of oral vascular malformations and the clinico-pathological features. MATERIALS AND METHODS: Histological sections of 103 consecutive cases filed as vascular malformations were reviewed for histopathological criteria of IPEH. RESULTS AND CONCLUSION: We found six cases of oral IPEH, of which three were diagnosed previously. Five of these cases were in males, and the mean age was 58 years. It was usually described as a blue or reddish nodule. The lower lip mucosa was the most common site followed by the tongue and the upper lip. Histologically, thrombi were always present and five out of the six lesions appeared in a mixed form, while only one was in a pure form. Three cases were diagnosed at an early stage and in the other three, the lesions were well-established. In this series, IPEH associated with vascular malformation was more common than reported in previous studies. Lesions at early stages, especially in the mixed form, may be unnoticed.     

Gorham–Stout disease with involvement of the jaws: a systematic review

The purpose of this study was to systematically review all published cases of Gorham–Stout disease (GSD) involving the jaws and to identify the clinico-radiological and histopathological features associated with persistence of the lesions, as well as the best treatment options available. An electronic search was undertaken in November 2018. Eligibility criteria included publications with sufficient information to confirm the diagnosis. Eighty-six publications reporting 89 cases were included. Features observed included symptomatic disease (51.1%), swelling (34.1%), pathological fracture (31.8%), history of previous trauma (32.1%), high alkaline phosphatase levels (24.3%), and predominance of vascular tissue (72.4%). Nearly a quarter of the patients were only followed up, with no treatment implemented. Most treatments consisted of some type of surgery with/without additional therapies (42.0%), drugs (20.5%), and radiotherapy (14.8%). Half of the cases were found to persist after some treatment modality, and five patients died. Among the variables investigated, only a lesion crossing the midline showed an association with persistence of the disease. There remains much to understand about GSD, a rare condition with no clear consensus on the aetiopathology, an unpredictable clinical course, and no standard treatment. The high rate of persistence after treatment was found to be associated only with the lesion crossing the midline.     

Reduction of syndecan-1 expression during lip carcinogenesis

Background:  Actinic cheilitis (AC) is an oral pre-cancerous lesion that sometimes develops into lip squamous cell carcinoma (SCC). Syndecan-1, a transmembrane heparan sulfate proteoglycan, modulates cell-proliferation, adhesion, migration and angiogenesis. Malignant epithelial cells often down-regulate their own syndecan-1 production, and are capable of inducing aberrant syndecan-1 expression in stromal cells. The aim of this study was to evaluate the variations in syndecan-1 expression during lip carcinogenesis, in normal lip (NL), AC and well-differentiated lip SCC.
Methods:  Biopsies of NL vermillion ( n  = 19), AC ( n  = 23) and lip SCC ( n  = 24) were stained immunohistochemically for syndecan-1.
Results:  Syndecan-1 expression was significantly reduced in AC and lip SCC as compared to NL ( P  < 0.05), with a significant reduction in lip SCC as compared to AC ( P  < 0.0001). In lip SCC lesions, syndecan-1 expression at the epithelium overlying the tumor was increased when compared to the tumor itself ( P  < 0.03), but was significantly reduced as compared to AC and NL ( P  < 0.001).
Conclusion:  The results showed that epithelial syndecan-1 expression is reduced as lip carcinogenesis progresses (NL>AC>lip SCC), suggesting that syndecan-1 could be a useful marker of malignant transformation in the lip.     

Surgical management of Squamous Cell Carcinoma of the lower lip: An experience of 109 cases

Objectives: We are presenting our experience collected from a series of 109 cases with SCC of the lower lip focusing on clinical features of patients and surgical approach. Study Design: We retrospectively analyzed medical records of patients diagnosed with Squamous Cell Carcinoma (SCC) of the lower lip at the Oral and Maxillofacial surgery at Xi’an Jiaotong University during a period between 1999 and 2008. Results: A total of 109 patients with lip cancer were included in the study. When no frozen-section test was performed, the neoplasia was removed with a margin of at least 6 mm. Different surgical techniques were used for lip reconstruction after tumor excision. Neck dissection was performed in all patients with clinically palpable lymph nodes. Median follow-up was 38 months. During follow-up, recurrence occurred in 5 patients, 3 patients developed neck metastases, distant metastases developed in 1 patient. Five patients died during observation period. Conclusions: The patient-related and defect-related issues must be taken into consideration during reconstruction for surgical defect. For N0 patients, we recommend wait-and-see policy. Early detection, careful follow-up and prompt neck is essential for the successful treatment. Key words:Lip cancer, surgical management, reconstruction.     

Correlation between clinical and histopathological diagnoses in periapical inflammatory lesions

Aim: The purpose of the present study was to evaluate the correlation between clinical and histopathological diagnoses of periapical inflammatory lesions, focusing mainly on cystic conditions. Methods: Files dating from 1998 to 2006 at the Oral Pathology Laboratory, School of Dentistry, Alfenas Federal University, Brazil, were reviewed to identify cases with histopathological diagnoses of periapical inflammatory lesions. A total of 1788 files were analyzed, and 255 cases were identified with clinical diagnoses of periapical inflammatory lesions. Results: The most prevalent clinical diagnosis was apical periodontal cyst (59%), followed by periapical granuloma (20%), and dentoalveolar abscess (2%). After histopathological analysis, 53% of the cases represented apical periodontal cyst, 42% periapical granuloma, and 5% dentoalveolar abscess. Conclusions: The outcomes of the present study show a high prevalence of periapical cysts among periapical inflammatory lesions. Moreover, this study highlights the importance of histopathological evaluation for the correct diagnosis of periapical inflammatory lesions.     

Characteristics of patients with orofacial granulomatosis

Oral Diseases (2011) 17 , 696–704 Objectives: Orofacial granulomatosis has mostly been described in reports of very small numbers of cases. Few large case groups have been described. The aim of this study was to describe the demographics, symptoms, clinical features and laboratory findings in a large cohort of cases. Subjects and Methods: Clinical and laboratory data for 119 cases of orofacial granulomatosis who attended oral medicine clinics in Dublin, Ireland, were examined for demographic characteristics at the time of first presentation. The male/female ratio was approximately 1:1, with a median age (and range) of 28 (5–84) years. Results: Symptoms had been present for a median duration of 12 weeks. A food association was suspected by 30% of patients. The predominant complaint was lip swelling (77%) with only 15% reporting facial swelling, while 8% complained of both. Almost all patients had clinical evidence of lip or facial swelling (95%). Other common extra‐oral manifestations were lip fissuring (30%), angular cheilitis (28%) and perioral erythema (28%). Common intra‐oral manifestations were cobblestoning of the buccal mucosa (63%), ulcers (36%), granulomatous gingivitis (33%), mucosal tags (29%) and fissured tongue (17%). Over half of the biopsies (56%) performed were reported as typical of orofacial granulomatosis. Conclusion: This is one of the largest cohorts of orofacial granulomatosis patients to have been described in detail.     

Correlation of addictive factors,human papilloma virus infection and histopathology of oral submucous fibrosis

J Oral Pathol Med (2010) 39 : 460–464 Background: Oral submucous fibrosis (OSMF) is a widely prevalent, potentially malignant disorder of the oral cavity in the Indian subcontinent. Areca nut has been incriminated as the main causative factor. However, other factors, including viruses may also play a role in the initiation/development of these lesions. This study was designed to assess the correlation of addictive factors, human papilloma virus infection and histopathology of OSMF. Methods: One hundred and thirteen cases of OSMF were studied. Demographic information of each patient, including the patient’s age, sex, addiction habits and histopathological grading was obtained. Presence of high‐risk human papilloma virus (HR‐HPV) DNA was detected using the Hybrid Capture II assay. Results: Of 105 cases finally included in the study, 33 (31.4%) patients were found to be positive for HR‐HPV, while 72 (68.6%) were negative. A total of 52/105 (49.5%) patients chewed areca nut, of whom 18 (34.6%) patients were found to be positive and 34 (63.5%) were negative (P = 0.08). A total of 18/105 (17.1%) patients were addicted to smoking, of whom five (27.7%) were positive (0.69). Only one (11.1%) patient, who was only habituated to alcohol, was positive (1.08). Of the 105 patients 26 (24.7%) chewed as well as smoked tobacco, of whom, nine (34.6%) were positive and 17(65.3%) were negative (P = 0.67). Thus, there was no significant association between the various addiction habits and the presence of HR‐HPV. On correlating the various histopathological grades of the disease with HR‐HPV positivity a Pearson correlation of 0.053 was obtained (P = 0.588). Thus, again no significant correlation was observed between the different histopathological grades and HR‐HPV positivity. Conclusion: In conclusion, it was found that there is neither significant correlation between HR‐HPV infection and the various addiction habits nor with the different histopathological grades of the disease. To the best of our knowledge, a study of these different factors has never been attempted before in patients with OSMF.     

DNA amplification and expression of FADD in oral squamous cell carcinoma

J Oral Pathol Med (2010) 39 : 525–532 Background: The Fas‐associated death domain‐containing protein, FADD, is an adaptor for relaying apoptotic signals. However, recent studies have shown that FADD also plays an important role in the growth and regulation of the cell cycle. The purpose of this study was to elucidate the role of FADD in oral squamous cell carcinoma (SCC). Methods: The DNA amplification of FADD from 30 samples of tongue SCC was analyzed using real‐time PCR and the protein expression of FADD from 60 samples of tongue SCC was analyzed using immunohistochemistry. Results: The DNA amplifications of FADD were observed in 13 cases (44.3%) and were significantly correlated with the histopathological differentiation grade of SCCs (P = 0.009). FADD expression levels compared with the matched adjacent epithelium increased significantly (P = 0.000). Additionally, the positive expressions of FADD were significantly correlated with lymph node metastasis of SCCs (P = 0.029) and the 5‐year disease‐specific survival rates (P = 0.049). A positive association between FADD expression level and the histopathological differentiation grade was found to be limited to T1 SCCs (P = 0.019). DNA amplification was moderately correlated (correlation coefficient = 0.406, P = 0.026) with expression of FADD in 30 samples of tongue SCC. Conclusion: In tongue SCCs, the expression of FADD was higher when compared with that of adjacent areas, which might be determined via genomic amplification in 11q13.3. Thus, SCC cells with the expression of FADD are possibly more likely to become metastatic and to worsen survival rates.     

Determining normal and abnormal lip shapes at border positions for use as a longitudinal surgical outcome measure

Objective measures of facial movement are important for interventions where surgical repositioning of facial structures can influence soft tissue mobility and include the management of patients with cleft lip, facial nerve palsy and orthognathic surgery. As such, the aim of this study is to present a method for determining the outcome of surgical procedures on lip shape during speech. A control group (CG) of 115 average subjects and 30 patients with a Class 3 malocclusion requiring bimaxillary surgery performed four reproducible verbal utterances during image capture using a non‐invasive, three‐dimensional (3D) motion scanner (3dMDFace? Dynamic System). Landmark coordinates around the lips of the 3D facial shells were extracted and subjected to discriminant analysis and principal component analysis to statistically differentiate lip shapes between the CG and the patient group (PG) pre‐ and post‐surgery. Pre‐surgically, the PG showed statistically significant differences in lip shape during speech in the lateral and vertical dimensions, preferring a wider, shorter lip shape when compared with the CG for all the utterances. The shape differences normalised towards the CG post‐surgery. The method presented utilises pre‐existing statistical shape analyses and can be reproduced in the clinical setting to provide a diagnostic and functional outcome tool. In this example, correction of the Class 3 skeletal disproportions appeared to normalise lip shape during speech.     

The prevalence of dysplasia and malignant lip lesions in transplant patients

J Oral Pathol Med (2012) 41 : 113–118 Background: Solid organ transplant patients are at an increased risk of developing lip malignancies. The role of HLA mismatch as a risk factor for such changes has only been described in skin. Methods: Lip lesions were evaluated in 403 solid organ transplant patients (immunosuppressed for at least 3 months) and findings compared to age and sex matched, otherwise healthy patients who acted as controls. HLA typing was provided for the transplant patients. All patients provided details of smoking history, alcohol consumption, skin type, as assessed by ease of burning to sunlight, and exposure to sunlight or other forms of ultraviolet radiation. Results: Lip lesions were identified in 36 transplant patients and 29 were biopsied. Fourteen of the biopsies confirmed dysplastic or malignant changes. For the control patients, one lesion was identified as dysplastic. The prevalence of dysplastic and malignant lip lesions was significantly higher (P = 0.006) in the transplant patients when compared to controls. Risk factors for dysplastic/malignant changes in the transplant group included age (P = 0.01), smoking (P = 0.033) and HLA‐B mismatch (P = 0.001). Lip covering provided a significant reduction (P = 0.045) in the development of lip changes. Conclusion: All transplant patients should be regularly screened for lip malignancies and consulted on smoking and sunlight exposure. HLA‐B mismatch does appear to make these patients more susceptible to dysplastic/malignant changes.     

Oral cavity squamous cell carcinoma survival by biopsy type: a cancer registry study

Background: Biopsy of a suspected oral squamous cell carcinoma (SCC) is important for diagnosis. Concerns have been raised about the potential for tumour spread by incisional biopsy techniques. This study aimed to investigate the five‐year survival and recurrence of oral SCC after incisional and excisional biopsy in total population data available from the Western Australian Cancer Registry (WACR). Methods: Total population data from the WACR, comprising all primary oral SCC cases diagnosed between 1990 and 1999, were examined. Information extracted included date of birth, gender, biopsy date, biopsy type, disease stage (TNM classification), disease site, date of recurrence and date of death. Records were excluded if the diagnosis was fine needle aspiration based, was not that of oral SCC and if a history was noted of another malignant neoplasm. Incisional and excisional biopsy cases were compared for five‐year survival, adjusting for disease stage. Results: No association was found between biopsy type and five‐year survival or recurrence amongst individuals with Stage I or II disease. Conclusions: In this study, biopsy type was not associated with survival of oral SCC patients with Stage I or II disease, adding to the evidence that incisional biopsy of oral SCC can be a safe procedure.     

The use of toluidine blue in the detection of pre‐malignant and malignant oral lesions

J Oral Pathol Med (2011) 40 : 300–304 Introduction: The purpose of this study was to evaluate the efficacy of the toluidine blue (TB) test as a diagnostic tool in the detection of malignant and dysplastic lesions of the oral cavity. This study was carried out because of a lack of consensus among different authors on the utility of TB, as well as to determine useful adjuncts to detect oral pre‐cancer and cancer. Materials and methods: The study included 160 patients with oral mucosal disorders that included suspicious or malignant lesions detected at clinical visual examination, confirmed by histopathological evaluation. All lesions were submitted to TB staining. Results: The sensitivity and specificity for the detection of malignant or dysplastic lesions by this test were 65.5% and 73.3%, respectively. Overall, the detection rate with TB (sensitivity) was slightly lower compared with those reported by other authors but the specificity was comparable to several reports. Positive predictive value (35.2%) was also lower than previous studies, whereas negative predictive value (90.6%) was similar. Conclusions: The simplicity of the test procedure and the validity of derived values suggest TB staining can be a valuable adjunct to the diagnostic process, as long as it is carefully correlated with the clinical characteristics of the mucosal disorder and histopathological diagnosis.     

Van der Woude syndrome: dentofacial features and implications for clinical practice

Background:  Van der Woude syndrome (VWS) is the most common clefting syndrome in humans. It is characterized by the association of congenital lower lip fistulae with cleft lip and/or cleft palate. VWS individuals have a high prevalence of hypodontia. Although caused by a single gene mutation, VWS has variable phenotypic expression. This study aimed to describe the range of clinical presentations in 22 individuals with VWS to facilitate its diagnosis.
Methods:  A retrospective study of 22 patients with a diagnosis of VWS was undertaken at the Australian Craniofacial Unit (ACFU) in Adelaide. Three extended families with affected members were included in the study cohort.
Results:  The overall prevalence of lip pits in this study cohort was 86%. Cleft phenotypes included bilateral cleft lip and palate (32%); unilateral cleft lip and palate (32%); submucous cleft palate (23%); and isolated cleft hard and soft palate (9%). Missing permanent teeth were reported in 86% of affected individuals.
Conclusions:  Submucous cleft palate in VWS may go undiagnosed if the lower lip pits are not detected. Associated hypodontia and resultant malocclusions will also require management by a dental team.